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General NPI Number Information
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NPI Number | 1912632167
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Entity Type | Organization
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Legal Business Name | COPPER RIVER NATIVE ASSOCIATION
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 111.5 RICHARDSON HWY
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City | COPPER CENTER
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State | AK
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Zip | 99573
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Country | US
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Telephone | 907-206-6812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 383
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City | GLENNALLEN
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State | AK
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Zip | 99588-0383
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Country | US
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Telephone | 907-602-6812
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Fax |
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Authorized Official
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Title or Position | PATIENT FINANCIAL SERVICES MANAGER
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Name | NIKKI R WIEDLUND
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Credential |
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Telephone | 907-206-6812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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